ANA Discussion Forum
General Category => AN Issues => Topic started by: Crazycat on October 23, 2007, 08:00:10 pm
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Hello everyone!
Sorry I haven't been around much recently as I've been very busy.
I recently had my yearly MRI scan on October 5th and consultation with my doctor on the 11th, the following week. I'm happy to report that there is no regrowth and I'm in excellent health.
While at the hospital during this latest round of check-ups, I took the liberty of requesting copies of my surgical records. Surgical records, as MRI scans, should be provided to a patient upon request. I called ahead of my consultation visit to let my neurosurgeon's assistant know that I'd be requesting copies of these documents which she readily provided for me upon my arrival. Included were the operative reports of my two shunt surgeries, the tumor resection as well as several radiology reports. While waiting for the doctor I had the most recent radiology report in my hand and knew that I was in good shape before he'd even stepped in the room to see me.
Attached below is the operative report of the tumor resection that I've transcribed for your perusal. I think that it's important and useful information for anyone facing AN surgery. From this you can either see what you've already been through or at least get a good idea of what you can expect to happen.
I'll transcribe the other reports for you if you're interested.
Take care, Paul
OPERATIVE REPORT.
PREOPERATIVE DIAGNOSIS: Large left acoustic neuroma (5cm).
POSTOPERATIVE DIAGNOSIS: Large left acoustic neuroma (5cm).
PROCEDURE: Left suboccipital microsurgical craniotomy for radical subtotal resection of acoustic neuroma, abdominal fat graft harvest, cranioplasty.
SURGEONS: Frederick Barker, M.D. and Michael McKenna, M.D.
ASSISTANT: Ziv Williams, M.D.
INDICATIONS: This man presented with a history of a large left cerebellopontine angle lesion, 5 cm in diameter. with moderate-to-severe hydrocephalus. A ventriculoperitoneal CSF shunt had been placed several weeks prior to operation to allow normalization of gait and to prepare for the tumor resection., which was undertaken today.
DESCRIPTION OF PROCEDURE: After the induction of satisfactory general endotracheal anesthesia, the patient was positioned supine with a blanket under the left shoulder and the head facing straight lateral toward the right in the Mayfield headrest. The left suboccipital area was widely clipped, prepped, and draped as was the left lower abdomen. We took care not to penetrate the CSF shunt with the Mayfield headrest.
An S-shaped extended suboccipital craniotomy incision was opened, pericranial graft harvested, suboccipital musculature stripped. A burr hole was placed and the subocciptal craniotomy was turned. The craniotomy was enlarged with Leksell and Kerrison ronguers to give a very generous exposure in the posterior fossa including the posterior edge of the lateral sinus, nearly down to the jugular bulb, and the inferior edge of the transverse sinus for several centimeters. The dura was opened in a stellate fashion. We accessed the basal cisterns easily because of the inferior extent of the craniotomy and drained CSF.
The operating microscope was used for the entire intradural operation. We defined the exposed tumor capsule, electrocoagulated it and incised it under the frozen section diagnosis, which was schwannoma. Of note, the tumor was extremely hypervascular and the entire operation was hindered by copious hemorrhage from the tumor at every step. We did a radical intracapsular debulking of the tumor and began to separate it from the lateral cerebellum and lateral penduncle. The tumor could be separated from the lower nerves, which were markedly distorted and displaced by the tumor. The tumor was not not adherent to the hypoglossal nerve, but was in contact with the vertebral artery. Rostrally, the tumor was separated from the IVth nerve, which was displaced in a remarkable fashion over the tentorium.
The trigeminal nerve was not yet seen, although a region of the brainstem in the normal region of the trigeminal nerve was encountered.
Dr. McKenna entered the operation and removed additional tumor from the petrous face, then electrocoagulated and reflected the dura of the of the petrous face and drilled the temporal bone to reveal the internal auditory canal.
I reentered the operation and continued a prolong process of debulking and tumor removal. In all, the microsurgical portion of this case lasted for approximately 9 hours. At the conclusion of the dissection, a clean plane could no longer be maintained either laterally, or medially, where indeed we did not locate the origin of the facial nerve on the lateral surface of the pontomedullary junction because of dense adherence to the medulla. However, the remaining tumor fragment was quite thinned and the brainstem was pulsatile throughout the exposure. The origin of the VIth nerve was well seen and the VIth nerve was intact as was the IVth nerve. The trigeminal nerve was freed from compression over a significant portion of its course. It had been displaced quite far inferiorly from its normal position. The remaining tumor fragment appeared quite thin, as we could stimulate the nerve through it with 0.3 mA in more than one place. The brainstem was pulsatile, although it had not come entirely back to its normal position - it was displaced across the midline at the beginning of the operation.
We placed a piece of Surgicel in the exposed portion of the residual tumor, harvested a fat graft in the left lower abdomen. This incision was closed with deep Vicryl sutures and an undyed Vicryl subcuticular stitch. The fat graft was placed into the internal auditory canal, which had been carefully waxed under microscopic control. The fat graft was held in place with a pledget of Surgicel. After thorough irrigation of the posterior fossa free of blood products, and instillation of 5mg of intrathecal vancomycin and 5mg intrathecal gentamycin because of the presence of the shunt, we closed the dura in a watertight fashion using the previously harvested pericranial graft. The bone plate was replaced into position and the 4.5 residual cranial defect was occluded with a titanium mesh cranioplasty. After further irrigation and hemostasis, the incision was closed in layers using Vicryl for the deep layers and a nylon running skin stitch. A sterile dressing was applied. The patient was released from the headrest and taken to the Blake 12 ICU, intubated, for further monitoring. The anesthesia service felt that because of facial and airway edema, extubation was not prudent. However, the patient demonstrated the ability to move all four extremities before resedation.
ATTESTATION: I was present or immediately available throughout the operation and performed its key neurosurgical portions personally. All material implanted during this operation is MRI compatible.
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Crazycat,
Thanks for sharing your report. Interesting. Makes me want to get a copy of my own surgical report. Was there any charge for it?
Jean
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Jeanlea,
There was no charge.
Paul
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;D Hey Good mornin' Paul!!
So happy for you that you have a clean MRI!! and thanks for the OR report--I had mine in 2001 art UMassMed Ctr and I have a copy of my Neurosurgeon's report and my Neurotologist's (spelling?) report as I always want copies of everything important for my files. It sounds like everything went well and they had everything under control... I just finished my 30 FSR treatments at MassGeneral (Dr Loeffler) as my tumor was not totally removed in 2001 (OR reports stated they had removed it all, but not true!!) . No problems w/treatment so now in one year I have an MRI and we'll see if that pesky AN has been finally halted!!
Looking forward to seeing you again and our motley crew ::) on Nov 11 at Maxwell's!!
Again, I am so thrilled for you that all is well!! Regards, Mary :)
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So glad to hear you have a clean MRI, Paul! I, too, find it strangely fascinating (and incredibly informative) to read through the post-op reports and notes. I had copies by the time I went back for my 6 week post-op checkup.
Jean, the report is part of your medical record. You should always be able to obtain copies of any part of your own medical record without fee. You will probably have to fill out a form and provide a signature, but that's it.
Katie
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Univ. of Miami charge $1.00 per page (highway robbery).
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Crazycat,
Congrats on the good MRI report. And thanks for the surgical report. I've have my surgical report, and all my radiology reports on the various MRIs. They're a good source of more detailed information.
Regards,
Rob
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That's a good idea to keep copies of those. We will be moving out of state within the next 2 years, and I'm sure it will be helpful to my new doctors. I had never thought to do that.
It's so interesting to read what actually happens during these surgeries. Makes me want to go hug the anaesthesiologist for keeping me in LaLa Land throughout it! And i find it funny that it sounds like a walk in park to the surgeons. "So we took his head apart and dug around for a while and then put it back together". I guess we should be glad they feel so at ease. Of course, it does make my day sound boring and uneventful in comparison.
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Thats good news!!
I think most ops, they will give a report while your in the hosp for free (If you ask for it!) .. once you leave there using a small "record filing" fee .
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Hi, Paul:
I was pleased to learn that your MRI result was positive. Congratulations!
Thanks for sharing your surgical reports. Interesting reading although wading through the Latin/medical jargon is daunting and why I hadn't much interest in seeing my surgical report (all went well so there was nothing to question) but I may ask for them, now, after realizing how informative they are.
Jim
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You're welcome and it's good to hear from all of you again.
Yes Jim, it is an effort having to wade through the medical terminology. It's like another language unto itself. I especially like the line: "We accessed the basal cisterns easily because of the inferior extent of the craniotomy and drained CSF." The "basal cisterns". It's like something from Isaac Asimov's "Fantastic Voyage".
It's good to have this information on-hand though for reference with any future medical situations we may be in. I still have all my medical records from birth up through adolescence.
Paul
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Thanks for sharing. I would suggest to those of you who want reports, to get them from your surgeon or neurotologist. They should have a copy of all the reports done by or sent to them and usually will not charge you. Hospitals, on the other hand, sometimes charge a rediculous fee based on the disclaimer that they have a "service" contracted to make copies.
Operative, pathology, and MRI reports should be available from your doctor's office with a smile and a polite request.
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Hi Paul, Glad things are going welll!
I too got a copy of my medical and surgical reports, Makes for some interesting reading.
On two of my medical reports I found descripancies. I was glad i checked as they were reporting misinformation to the insurance companies.
In FL they can charge a dollar a page but only up to 25.00. I know one of my doctor charges so I had my records sent free of charge to another doctor and picked up my records from them ;)
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Yes, they were free from my doctor's office, within the hospital. His office is located on the Mass General campus.
Good to hear from you Michelle! I'm Heading down to Florida to visit Jody for a few weeks. Leaving the 11th.
Paul